Continuous arteriovenous hemofiltration therapy for Staphylococcus aureus-induced septicemia in immature swine

Lee, Patrice A.; Matson, James R.; Pryor, Robert W.; Hinshaw, Lerner B.

doi:10.1097/00003246-199306000-00022

Cited by 118 publications

(50 citation statements)

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“…Mediators considered able to be filtered, or those that indeed have been assessed in hemofiltrate, are for example cytokines, 5,8,24,25 activated factors of the complement system,4'5,8 arachidonic acid metabolites,4'5'26 platelet-activating factor,5'27 myocardial depressant factor,7 kinins,3'5 and phospholipase A2.8…”

Section: Discussionmentioning

confidence: 99%

Influence of Zero-Balanced Hemofiltration on the Course of Severe Experimental Pancreatitis in Pigs

Yekebas

Treede²,

Knoefel³

et al. 1999

Annals of Surgery

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ObjectiveTo examine the impact of continuous venovenous hemofiltration (CVVH) on the course of experimental pancreatitis in pigs. Summary Background DataThe activation of different mediator cascades is assumed to trigger multiple organ dysfunction or failure during necrotizing pancreatitis. CVVH has been suggested to be beneficial in those instances by eliminating several inflammatory mediators released in the circulation. MethodsPancreatitis was induced by a combined intraductal injection of sodium taurocholate and enterokinase. Control group animals received no treatment after induction. A second group underwent "therapeutic" CVVH after a 20% decline of mean arterial pressure. In the third group, "prophylactic" CVVH was started simultaneously with the induction of pancreatitis.The concentrations of tumor necrosis factor-alpha, transforming growth factor-beta1, kinin, and phospholipase A2 were measured at different time points in blood (preand postfilter) and in the hemofiltrate to calculate the respective sieving coefficients that reflect most accurately the plasma clearance of mediators by CVVH. ResultsSurvival time was significantly prolonged both by therapeutic and prophylactic CVVH; it was more pronounced in the latter. CVVH did not influence the increase in transforming growth factor concentrations. However, 6 hours after induction, the increases of plasma concentrations of tumor necrosis factor, phospholipase, and kinin were significantly weakened by CVVH compared with controls. In the treatment groups, the plasma concentrations of tumor necrosis factor and phospholipase showed a significant negative correlation with the respective sieving coefficients, which decreased in the later course of the experiments. ConclusionsExpenmental necrotizing pancreatitis was associated with a tremendous increase of plasma concentrations of tumor necrosis factor, phospholipase, and kinin. The effective removal of these mediators by CVVH resulted in significantly improved survival time. Animals that received prophylactic CVVH had a longer survival period than those in which CVVH was started after clinical impairment. The decreasing efficiency of CVVH in eliminating inflammatory mediators in the later course of the experiments suggested that the filter membranes were compromised by long-term application. These findings provide further evidence that CVVH offers therapeutic options even in the absence of conventional indications for blood-purifying treatments.Because appropriate fluid resuscitation has been accepted for early therapy in acute pancreatitis, hypovolemic shock is no longer responsible for deaths from this disease. However, the development of extensive necrosis, resulting in The aim of the present study was therefore to evaluate the effect of continuous venovenous hemofiltration (CVVH) on the plasma concentrations and activities of inflammatory mediators in a porcine model of severe necrotizing pancreatitis. Moreover, we investigated whether the removal of pancreatitis-related mediators by CVVH would result in a...

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Section: Discussionmentioning

confidence: 99%

Influence of Zero-Balanced Hemofiltration on the Course of Severe Experimental Pancreatitis in Pigs

Yekebas

Treede²,

Knoefel³

et al. 1999

Annals of Surgery

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“…In the past two decades, animal experiments have shown that hemofiltration significantly improves survival rates in sepsis (7). Continuous venovenous hemofiltration (CVVH) is a technique of renal replacement therapy in critically ill patients, that may partially attenuate the inflammatory process by removal of cytokines.…”

mentioning

confidence: 99%

Toll-like Receptor Kinetics in Septic Shock Patients: A Preliminary Study

Piazza

Pulcrano²,

Fiori

et al. 2012

Int J Immunopathol Pharmacol

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The aim of this study is to evaluate some inflammatory parameter changes in septic shock patients and their possible correlation with clinical outcome, in particular when continuous veno-venous hemofiltration (CVVH) treatment is required. Considering the objective difficulty in enrolling this kind of patient, a preliminary study was initiated on seventeen septic shock patients admitted to a medical and surgical ICU. The mRNA expression of Toll-like receptor (TLR)-1, TLR-2, TLR-4, TLR-5, TLR-9, TNFα, IL-8 and IL-1β was assessed, the plasmatic concentrations of IL-18, IL-2, IL-10 and TNFα were measured on the day of sepsis diagnosis and after 72 h. In those patients who developed acute renal failure unresponsive to medical treatment and who underwent CVVH treatment the same parameters were measured every 24 h during CVVH and after completion of the treatment. On sepsis diagnosis, gene expression of TLRs was up-regulated compared to the housekeeping gene in all the patients. After 72 h, in 35% of the patients a down-regulation of these genes was found compared to day 1, but it was not associated with a reduction of cytokine serum levels or improved clinical signs, better outcome or reduced mortality. After high volume hemofiltration treatment, cytokine serum levels and TLR expression were not significantly modified. In conclusion, considering the not numerous number of cases, from our preliminary study, we cannot certainly correlate TLR over-expression in septic shock patients with severity or outcome scores.

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“…A direct correlation could be demonstrated. Significant improvements in cardiac function, systemic and pulmonary vascular resistance and hepatic perfusion [76] were found. Another study in lambs showed significant improvements in lung function [79].…”

Section: Crrtmentioning

confidence: 91%

“…In three of them [76][77][78] the correlation of survival with ultrafiltration rate was specifically examined. A direct correlation could be demonstrated.…”

Section: Crrtmentioning

confidence: 99%

Extracorporeal Therapies in Non-Renal Disease: Treatment of Sepsis and the Peak Concentration Hypothesis

et al. 2004

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In the setting of intensive care, patients with acute renal failure often present a clinical picture of the systemic inflammatory response syndrome (SIRS). SIRS can be caused by bacterial stimuli or by non-microbiological stimuli that induce a significant inflammatory response. When this response is exaggerated, the patient experiences multiple organ system failure and a condition of sepsis also defined as a systemic malignant inflammation. This is mostly characterized by an invasion of cytokines and other pro-inflammatory mediators into the systemic circulation where major biological effects take place, including vasopermeabilization, hypotension and shock. At the same time, the monocyte of the septic patient seems to be hyporesponsive to inflammatory stimuli to a certain extent. In this condition, the patient faces a situation of hyperinflammation but at the same time of immunodepression expressing a clinical entity defined as counter anti-inflammatory response syndrome. The general picture of the clinical disorder is therefore better characterized by an immunodysregulation than by a simple pro- or anti-inflammatory disorder. Due to the short half-life of cytokines and other mediators spilled over into the circulation, it is extremely difficult to approach the problem at the right moment with the right pharmacological agent. For these reasons, the peak concentration hypothesis suggests that continuous renal replacement therapies, due to their continuity and unspecific capacity of removal, might be beneficial in cutting the peaks of the concentrations of both pro- and anti-inflammatory mediators, restoring a situation of immunohomeostasis. Thus the patient may benefit from a lesser degree of immunodysregulation and he/she may restore a close-to-normal capacity of response to exogenous stimuli.

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Continuous arteriovenous hemofiltration therapy for Staphylococcus aureus-induced septicemia in immature swine

Cited by 118 publications

References 0 publications

Influence of Zero-Balanced Hemofiltration on the Course of Severe Experimental Pancreatitis in Pigs

Influence of Zero-Balanced Hemofiltration on the Course of Severe Experimental Pancreatitis in Pigs

Toll-like Receptor Kinetics in Septic Shock Patients: A Preliminary Study

Extracorporeal Therapies in Non-Renal Disease: Treatment of Sepsis and the Peak Concentration Hypothesis

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